Kaiser "No Options" Program

So, while waiting to get my classes waived by the DMHC, I have to take Kaiser's Options program.  It's 12 weeks (for those of you who don't already know). 

Day 1 went exactly as expected.  The nutritionist was there and gave a 90 minute lecture on how to eat after our "Roux en Y" procedure.  Despite the fact that she had at least a few Sleeve patients there as well as ME--the only DSr, all she spoke of was the RNY. This is the BS that I was given:

1: Don't eat any red meat. It'll clog my arteries and it's full of fat.
(DSrs get to eat red meat, especially since we only absorb 20% of fat!)

2. Don't eat any fat. There is enough naturally occurring in food like chicken or fish--avoid fat at all costs.(DSrs need SOME fat or we'll never poop, right?)

4. Avoid all sugars and well as fat because I'll get dumping syndrome and experience severe diarrhea--severe--severe.  (Not that I plan to eat sugar, but I don't plan on having dumping syndrome either since I retain my stomach and pyloric valve etc. OH, and the diarrhea can be controlled by diet I'm hoping)

3. Don't ever drink juice.  It's just empty calories.  (One cup of juice every now and then won't kill anyone)

4. Carbs don't matter--just count calories. Eat carbs--they're good for you. You can eat 206 grams of carbs a day and be just fine--even if you're diabetic. (206?? Isn't that a bit much?Um...enough said, right? MORON)

5. Don't drink or eat any cafinated products after the surgery. (Not sure about this one, but the DSrs I know, all seem to drink their daily cup(s) of coffee)

6. Never eat popcorn after the surgery. (Um...never heard that one before)

7. Get used to eating 1200 calories a day since that'll be all I can eat after surgery--for the rest of my life.  Make sure to eat several small meals a day since I won't have any room for a regular sized meal (which will make me very sick and again, get dumping syndrome). (Not me! I'll get to eat a whole meal eventually since my stomach won't always be the size of an egg and 1200 calories probably won't be enough I'm guessing. DianaCox says she eats about 3000 a day)

8. Don't eat the yellow part of eggs.  Eat one whole egg but make sure to use only egg whites to add bulk--there is just too much fat in eggs to eat more than one yolk. (In this case, fat is good for you--just add some mayo, some relish, and a dash of mustard and you've got a great egg salad!)

9. The only source of pure protein is in egg whites. (Not so worried about pure protein since I get to have red meat--with fat!)
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Obviously, this information doesn't pertain to the DSrs.  I felt like it was 90 minutes of my life wasted.  I could have been reading a book (I intend to do that next class meeting), I could have been getting a manicure or pedicure, I could have seen a movie, I could have had coffee with a friend, I could have been playing with my 17 month old daughter....

...what else could I have done with those 90 minutes that Kaiser has forced me into wasting every week for 12 weeks?

During class I did my best to just be polite, look up every now and again as I played on my phone:  a few games of Gin Rummy, read my facebook status updates, read the news, and texted a few people. Next week, I'll find a nice cozy spot in back and bring a good book and catch up on the latest novel I'm reading.

Wish me luck. OH, and after class, the nutritionist came over to me and I explained that I was a DS patient. "What's that? Isn't it sort of like the RNY?" she said.  I explained what it was and it's benefits and then wrote down the website to dsfacts.com . She then said, "Why would you want to do that to yourself? Why don't you just get the RNY? We've had so much success with the RNY patients."

My response was, "You know as well as I do that RNY patients have a high rate of failure a regain their weight back eventually.  Plus, diabetes is more effectively managed with the DS."

She the said again, "Are you sure you want to do this? Really, the RNY is a great surgery." So, I said these words exactly, "I just had to report your director [of education for the weight management program] to the California Nursing Board because she was questioning my doctor's decision to give me the DS and for giving inaccurate advice. Please don't make me have to report you as well. Just keep your opinions to yourself."

It was at this point that she asked me for my name and wanted my surgeon's number.  Not sure what she'll do with that, but the decision has already been made. I'm getting the surgery. I doubt Belzberg gives **** what some nutritionist has to say.

So, that was my day (and my long, long rant). Thanks for reading!

S

How many classes do you think you will have to attend before you hear a final decision from the
DMHC ? I ask this because that is exactly what I will be doing on my daughters behalf. She just met with her PCP about a week and a half ago and she said we would get a letter in the mail. I don't exactly know what the letter will entail, but as soon as she has been instructed to take the options classes I will send in the appeal to opt out of the classes.

Am I doing this right ?

Hi Pumpkin X,
I'm not sure how many classes I'll have to take. I'm 3 behind because I didn't start when I was supposed to.  They aren't supposed to let you miss 3 classes but the head of the program was very unethical and put me in a position where i didn't want to go to class and be in the same room with her.  It's been sort of resolved so I'm back in the program until I hear from the DMHC.  I'm guessing I'll have to attend all of August (that's at least 4 classes) and if I take any of the make ups then I'll have to take 3 extra as well.  So perhaps 7 or more.  The process with the DMHC takes a while.  Kaiser stalls them as much as possible.  I had my complaint in there July 15 and it just went into IMR earlier this week.  That's a month!  It took Kaiser quite a bit of time to respond to the DMHC's request for information.  Now that a month has passed, I probably have another 30 days before hearing their decision.  So you can figure you've got a pretty good chance of a 2 month delay from start to finish--but it could take longer.

As far as I know, you don't have to wait to get your letter regarding the Options classes.  I'd ask DianaCox or Larra.  They are both here on DMHC.  You can send them a personal message if you'd like.  If I were in your shoes, I'd go ahead and file a complaint with the DMHC.  They'll end up going back to Kaiser and kaiser will tell them the classes are medically necessary.  That will throw the complain into an IMR file--which takes longer but it'll probably have to go that way.  In the mean time, I'd go online and file an immediate grievance with Kaiser stating your reasons for not wanting or needing to take the Options classes.  They will most likely turn you down and send the grievance back for a second time.  As all of this is happening, you'll get your letter telling you when and where Options orientation will be, and your paperwork with the DMHC will be in process.  As far as I know you can do all of this simultaniously. 

I didn't do it this way. I saw my PCP, got the letter.  I filed the Kaiser grievance before going to Orientation.  I didn't go through the DMHC because I thought Kaiser would waive the classes.  I went to orientation and sat quietly for a hour and a half.  Then waited and waited and waited to hear from Kaiser regarding my grievance.  When they turned me down the first time I went straight to the DMHC with my complaint.  Meanwhile, Kaiser turned me down a second time.  Then DMHC worked hard to comvince them to waive the classes BEFORE going into the IMR process.  But it was to no avail.  And now, it's another waiting game.

Which kaiser are you with? Northern or Southern CA.  Where specifically?

Sheri

I'm at So. Cal. W. Hills Kaiser.

I'll shoot Diana an email right now

THANKS.

One more bit of advice for you.  You're at the same Kaiser that I'm at.  So they're now familiar with me and the DS.  I WOULD NOT reveal my cards right now.  Don't tell them that you're interested in the DS yet.  Get those classes waived first, then go for the DS.  It'll make life easier for you.  I did it in the wrong order and I think it made things worse.

So, my advice to you is to work on the classes, then go for the surgery.  You can be very general in your complaint/grievance stating that you want weight loss surgery but that it's not legally required per the many decisions made by the DMHC.  That way, kaiser may actually waive the classes on their own.  But if they think you're gunning for the DS you may have a larger battle at hand.  This is especially since my doc already approved my DS.  That's at least 2 in the past 7 months (another one of us here on the board got it from them as well). 

Also, the director of the weight loss program--Diana Jones is very prejudiced against this surgery.  She's negative and gives out false info. I'm reporting her to the CA nursing board.  Do not give her (or anyone else in health ed) the info that you're doing the DS just yet.  They're all going to treat you differently and be more of a road block for you.  I wish I knew this going in.  Now that my name is out there with all sorts of road blocks and preconceived notions, I just have to deal with it--and try to advocate for other DSrs.

Sheri,
 Thank you so much for taking the time and helping me with Kaiser. It is actually my daughter who will be having surgery and she will be revising to the sleeve. I'm lucky she is revising at all. She had a rough time with both of her lap bands and it took me posting her story on the main forum and all the extremely helpful people who took the time to reply that actually got her to reconsider a revision at all.

I appreciate any and all direction from you regarding Kaisers WLS program. So far she has only seen her PCP for a referral into the program, and as of today we haven't heard anything yet. How long was it from your PCP visit till you received any response back from Kaiser and what was that next step ?


Thanks

,

I think it took about 2 weeks before I got frustrated and called the health education department myself to find out if they'd gotten the referral.  If she's at Kaiser Woodland Hills, then you can call this number to make sure they got the referral (818-719-4305) and ask to speak to Nubia.  She'll be able to tell you if the referral went in.  If not, then keep calling until you get a yes.  From there, it took another 2-3 weeks to get the letter in the mail confirming my admittance to the Options orientation.  Then the classes didn't start until 3 weeks after the orientation.  I went to the PCP in May and had orientation June 29th and classes started July 22.  So, as I said, I wouldn't wait for all of that. I'd just start the grievance process now.  It'll give you more time.  Meanwhile, she should go to the orientation--just in case she has to take the classes anyway.  I'm going to classes because if the DMHC denys my appeal then I end up being weeks behind schedule. 

Here is the order:
1. PCP referrs to health ed bariatrics program (Options)
2. Phone call or letter (or both) comes from Nubia to confirm her spot at orientation--date will be given at that time. ( Left a message requesting that they CALL me to confirm my reservation)
3. At orientation, she gets info on the 3 surgeries that kaiser "officially" covers--the Sleeve, the RNY, and the lap-band. She'll be asked if she wants to take classes and start right away or if she wants to bypass classes and see the surgeon. If she bypasses classes to see surgeon, she gets put on the waiting list for the next session. Don't bypass the classes.  The surgeon is likely to send her back to Options (the establishment tells them to do this. I have confirmation directly from the horses mouth) and the process is delayed even further. She should agree to start classes right away. 
Classes start probably no sooner than a month later
4. Start classes and work on the grievances.

I'm not sure how Kaiser approaches revisions.  But I can tell you that if she wants the sleeve, they will gladly give her one if she meets criteria.  I was told that 90% of patients from my options program get the sleeve (this was told by the nurse).  And the surgeon I went to also recommends the sleeve to patients--because of the lack of dumping, presovation of the pyloric valve, etc. So, getting the sleeve (if they do revisions and if she meets standard criteria--bmi of 38 with a co-morbidiy or bmi of 40 with or without co-morbidities) shouldn't be a problem there.  For those of us getting the BPD-DS, it's a struggle with them.  Longer surgery, more invasive and more aftercare, and a lifelong committment to proper nutrition and vitamins--makes them nervous that we won't fair well.  Of course if they'd get some health educators who knew somthing about the DS then we'd be in a much better place.

Good luck and please keep me posted.

Awesome and very helpful information THANK YOU VERY MUCH.

A very smart friend of mine called Kaiser and spoke with a nurse in charge of the bariatrics dept. It may have been Nubia if she is the head RN there. She told my friend that since my daughter is a revision surgery.... that she will only have to wait for three months total. I'm hoping this is correct. I'll check with my friend and see if she remembers any of this.

Thanks and I will keep you informed. Good luck with your journey

The head nurse of bariatrics health ed is Diana Jones. She's the one I've filed the complaint against.  NOT a trustworthy lady and very emotional about her own agenda.  She actually said, "I APPEAL to you as a MOTHER, don't get this surgery (the DS). It's going to kill you." She gave all sorts of false info that was contradictory to what my doctor has said and that was unprofessional.  It's unbelievable.  Not sure why she's giving you the 3 month timeframe.  Did your daughter already take classes somewhere?

S

We didn't even have Kaiser when that statement was made to my friend. We still had about two months till we changed our ins. I was calling around inquiring about if Kaiser had the " One WLS per lifetime policy "